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Patient Demographic and Tumor Characteristics Influencing Oncologist Follow-Up Frequency in Older Breast Cancer Survivors

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although recommendations for breast cancer follow-up frequency exist, current follow-up guidelines are standardized, without consideration of individual patient characteristics. Some studies suggest oncologists are using these characteristics to tailor follow-up recommendations, but it is unclear how this is translating into practice. The objective of this study was to examine current patterns of oncologist breast cancer follow-up and determine the association between patient and tumor characteristics and follow-up frequency.

Methods

The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify stage I–III breast cancer patients diagnosed 2000–2007 (n = 39,241). Oncologist follow-up visits were defined using Medicare specialty provider codes and the linked AMA Masterfile. Multinomial logistic regression determined the association between patient and tumor characteristics and oncologist follow-up visit frequency.

Results

Younger age (p < 0.001), positive nodes (p < 0.001), estrogen receptor/progesterone receptor positivity (p < 0.001), and increasing treatment intensity (p < 0.001) were most strongly associated with more frequent follow-up. However, after accounting for these characteristics, significant variation in follow-up frequency was observed. In addition to patient factors, the number and types of oncologists involved in follow-up were associated with follow-up frequency (p < 0.001). Types of oncologists providing follow-up varied, with medical oncologists the sole providers of follow-up for 19–51 % of breast cancer survivors. Overall, 58 % of patients received surgical oncology, and 51 % undergoing radiation received radiation oncology follow-up, usually in combination with medical oncology.

Conclusions

Significant variation in breast cancer follow-up frequency exists. Developing follow-up guidelines tailored for patient, tumor, and treatment characteristics while also providing guidance on who should provide follow-up has the potential to increase clinical efficiency.

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Acknowledgment

This project was funded under Contract No. HHSA290201000006I from the Agency for Healthcare Research and Quality (AHRQ) as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program. Further funding came from a Clinical Scholar Award from the Society of University Surgeons; an investigator-initiated pilot grant from the University of Wisconsin Carbone Cancer Center; Grant number P30 CA014520 from the National Cancer Institute with support to the University of Wisconsin Carbone Comprehensive Cancer Center (UWCCC); as well as the Health Innovation Program, the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research [Grant number UL1TR0000427 from the Clinical and Translational Science Award program of the National Center for Research Resources, NIH National Center for Advancing Translational Sciences (NCATS)] and the UW School of Medicine and Public Health from The Wisconsin Partnership Program. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.

Disclosure

The authors declare no conflict of interest. The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Surgery, UW Madison School of Medicine and Public Health, CSC H4/726, 600 Highland Ave., Madison, WI, USA

    Heather B. Neuman MD, MS, Jeffrey Havlena MS, Maureen A. Smith MD, MPH, PhD & Caprice C. Greenberg MD, MPH

  2. UW Carbone Cancer Center, UW Madison School of Medicine and Public Health, Madison, WI, USA

    Heather B. Neuman MD, MS, Jennifer M. Weiss MD, MS, Noelle K. LoConte MD & Maureen A. Smith MD, MPH, PhD

  3. Division of Gastroenterology and Hepatology, Department of Medicine, UW Madison School of Medicine and Public Health, Madison, WI, USA

    Jennifer M. Weiss MD, MS

  4. Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA, USA

    Deborah Schrag MD, MPH

  5. Department of Population Health Sciences, UW Madison School of Medicine and Public Health, Madison, WI, USA

    Katie Ronk BS & Maureen A. Smith MD, MPH, PhD

  6. Division of Hematology and Oncology, Department of Medicine, UW Madison School of Medicine and Public Health, Madison, WI, USA

    Noelle K. LoConte MD

  7. Department of Family Medicine, UW Madison School of Medicine and Public Health, Madison, WI, USA

    Maureen A. Smith MD, MPH, PhD

Authors
  1. Heather B. Neuman MD, MS
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  2. Jennifer M. Weiss MD, MS
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  3. Deborah Schrag MD, MPH
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  4. Katie Ronk BS
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  5. Jeffrey Havlena MS
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  6. Noelle K. LoConte MD
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  7. Maureen A. Smith MD, MPH, PhD
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  8. Caprice C. Greenberg MD, MPH
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Corresponding author

Correspondence to Heather B. Neuman MD, MS.

Appendix

Appendix

See Table 3.

Table 3 Codes used to determine treatment received
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Neuman, H.B., Weiss, J.M., Schrag, D. et al. Patient Demographic and Tumor Characteristics Influencing Oncologist Follow-Up Frequency in Older Breast Cancer Survivors. Ann Surg Oncol 20, 4128–4136 (2013). https://doi.org/10.1245/s10434-013-3170-8

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  • DOI: https://doi.org/10.1245/s10434-013-3170-8

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